Provider Demographics
NPI:1972213387
Name:COLBERT COUNSELING LLC
Entity type:Organization
Organization Name:COLBERT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:971-563-5771
Mailing Address - Street 1:1278 GAR HWY UNIT 501
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02777-7722
Mailing Address - Country:US
Mailing Address - Phone:971-563-5771
Mailing Address - Fax:
Practice Address - Street 1:442 WILBUR AVE
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:MA
Practice Address - Zip Code:02777-2406
Practice Address - Country:US
Practice Address - Phone:508-916-6839
Practice Address - Fax:508-804-7153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-28
Last Update Date:2024-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)